Select Committee on Science and Technology Written Evidence

Letter from PHLS South West Group

  I am writing in my capacity as Group Director of the Public Health Laboratory Service South West Group. The Group comprises 10 clinical microbiology laboratories in South West England, two reference laboratories (Leptospira, Mycology) and three specialist units (food microbiology, primary care and vaccine evaluation).

  Since the creation of the Group in 1995, its focus has been firmly on public health microbiology, ie a focus on microbial interactions with populations, over and above the interactions with individuals. The Group has two particular research interests at present:

  The first is to explore the effect of a variable sampling by general practitioners on the ascertainment of a range of common community-acquired infections (including urinary track and chlamydial infections). We have demonstrated wide variations in remission of specimens by general practitioners, resulting in substantial under ascertainment of community-acquired infections.

  The second is a wide-ranging programme of work (including a number of external collaborations) relating to the ascertainment and control of pneumococcal infections. The latter programme has been developed in response to the opportunities offered by the new generation of conjugated pneumococcal vaccines that are now coming into clinical use. The PHLS SW programme is geared to making major improvements in the diagnosis of pneumococcal respiratory infections and to identifying candidate components for pneumococcal vaccines. For contest, there are about 6,000 episodes of invasive pneumococcal infection each year in England and Wales, and probably some 20,000 to 40,000 episodes of pneumococcal pneumonia. Most of the former, and many of the latter may be preventable by vaccination.

  Both of these initiatives have required the active participation and support of several of the laboratories within the Group. They have also required championing by individual consultants within those laboratories.

  The Sub-Committee will be aware of the impending transfer of management of most Public Health Laboratories to the NHS, as part of the process of creating the new Health Protection Agency. My colleagues and I perceive four principal dangers in this transfer:

  First, and most importantly, we believe that a schism will develop between microbiologists and epidemiologists, with poorer, and not improved standards of reporting of infections by laboratories as the result.

  Secondly, we believe that the break-up of networks of laboratories with proven public health outputs will seriously imperil current programmes of work such as those outlined above. It is a real possibility that most or all of the PHLS South West programmes of collaborative work will cease soon after 1 April 2003.

  Thirdly, we have no confidence whatsoever that the transfers of PHLS laboratories to the NHS will be cost-neutral. All the evidence available to us to date points to the retention of significant amounts of funding by the Department of Health and to the loss of current PHLS efficiencies through the break up of the network. This will exacerbate the risk of deterioration of public health microbiology outputs.

  Finally, we are already seeing clear evidence of demotivation of key individuals within our laboratories, especially those whose interest is in public health, rather than clinical (patient-focusd) microbiology.

  The UK enjoys an enviable reputation globally for the quality of communicable disease surveillance and control, based on robust evidence. This reputation reflects the strength of partnership working by specialists across the field, particularly over the last 10 years or so. Opportunities for improvement in communicable disease control and for real gains in public health have never been stronger, as a result of the development of new vaccines and other interventions.

  The CMO's communicable disease strategy "Getting Ahead of the Curve" sets out a vision for improved control of communicable diseases in England. This vision is endorsed by most UK microbiologists. Yet the translation of that vision into reality will only occur if the risks outlined above are addressed in a constructive and positive way. Disenfranchisement of the microbiological community, which is the current perception, will lead to poorer quality surveillance and may take years to overcome.

  I hope these comments are helpful. Please do not hesitate to contact me if you need any clarification.

Prof Keith A V Cartwright

Group Director

October 2002

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